Abstract
BackgroundContemporary data remains limited regarding mortality and major adverse cardiac events (MACE) outcomes in patients undergoing PCI for different manifestations of coronary artery disease.ObjectivesWe evaluated mortality and MACE outcomes in patients treated with PCI for STEMI (ST-elevation myocardial infarction), NSTEMI (non ST-elevation myocardial infarction) and stable angina through analysis of data derived from the Nobori-2 study.MethodsClinical endpoints were cardiac mortality and MACE (a composite of cardiac death, myocardial infarction and target vessel revascularization).Results1909 patients who underwent PCI were studied; 1332 with stable angina, 248 with STEMI and 329 with NSTEMI. Age-adjusted Charlson co-morbidity index was greatest in the NSTEMI cohort (3.78±1.91) and lowest in the stable angina cohort (3.00±1.69); P<0.0001. Following Cox multivariate analysis cardiac mortality was independently worse in the NSTEMI vs the stable angina cohort (HR 2.31 (1.10–4.87), p = 0.028) but not significantly different for STEMI vs stable angina cohort (HR 0.72 (0.16–3.19), p = 0.67). Similar observations were recorded for MACE (<180 days) (NSTEMI vs stable angina: HR 2.34 (1.21–4.55), p = 0.012; STEMI vs stable angina: HR 2.19 (0.97–4.98), p = 0.061.ConclusionsThe longer-term Cardiac mortality and MACE were significantly worse for patients following PCI for NSTEMI even after adjustment of clinical demographics and Charlson co-morbidity index whilst the longer-term prognosis of patients following PCI STEMI was favorable, with similar outcomes as those patients with stable angina following PCI.
Highlights
Percutaneous coronary intervention (PCI) has become the revascularisation therapy of choice in patients with both stable coronary artery disease and acute coronary syndromes
The longer-term Cardiac mortality and major adverse cardiac events (MACE) were significantly worse for patients following PCI for non ST-elevation myocardial infarction (NSTEMI) even after adjustment of clinical demographics and Charlson co-morbidity index whilst the longer-term prognosis of patients following PCI ST-elevation myocardial infarction (STEMI) was favorable, with similar outcomes as those patients with stable angina following PCI
A total of 1332 patients who underwent PCI had a diagnosis of stable angina (69.7%) whilst 577 patients were diagnosed with ACS (30.3%). 248 of the patients with ACS presented with STEMI (43%) whilst 329 patients presented with NSTEMI (57%)
Summary
Percutaneous coronary intervention (PCI) has become the revascularisation therapy of choice in patients with both stable coronary artery disease and acute coronary syndromes. Despite this, contemporary data remains limited regarding mortality and major adverse cardiac events (MACE) outcomes when comparing across the spectrum of patients with different indications for PCI in a ‘‘real-life’’ setting. Other studies have reported the opposite in the long term [6] and only few studies have compared the outcome of these patient groups to those undergoing elective PCI [6]. Contemporary data remains limited regarding mortality and major adverse cardiac events (MACE) outcomes in patients undergoing PCI for different manifestations of coronary artery disease
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